Patient Preference or High Fear: A Case Report Describing Outcomes from Manual Therapy and Modalities for a Patient with Chronic Back Pain


  • Tyler Daniel Craun University of Florida



Background and Purpose:  Research has shown that psychological factors are often associated with the development and continuation of chronic back pain. When these factors are present in a case of chronic back pain, it is unclear as to what type of physical therapy approach should be utilized in order to best improve functional ability. The purpose of this case report is to describe the outcomes of a physical therapy treatment focusing on modalities and manual therapy based on the preference of a patient with chronic back pain and high fear.

Case Description:  A 67-year-old female presented with chronic back pain affecting her ability to perform functional activities. Scores on the Oswestry Disability Questionnaire and Fear-Avoidance Belief Questionnaire indicated disability and high fear of pain, respectively. Active trunk and cervical ROM were limited. The patient was seen for 7 visits over 4 weeks. Treatment primarily focused on modalities and manual therapy based on patient preference.  

Outcomes:  No meaningful improvements on the NPRS, ODQ, FABQPA, or PCS were observed over the 4 weeks of treatment. Active trunk and cervical ROM measurements remained similar throughout treatment.

Discussion:  Some clinicians may fall into the temptation of providing passive treatments for patients with chronic back pain when patients explicitly express a strong preference for these types of interventions. When the patient preference of modalities and manual therapy was the primary focus in treatment, no meaningful improvements in level of pain, functional ability, fear of pain, or pain catastrophizing were observed in this case. Further research is needed to determine treatments for chronic back pain that are effective in addressing the physical and psychological aspects of the condition.